Thursday, September 10, 2009

Schering-Plough: Committed to Corrupting every last Psychiatrist?

Since my last post about Schering-Plough's campaign to buy off doctors with invitations to join its Speaker's Bureau, a number of my colleagues have reported receiving their own invitations. Strangely, many of them are prominent opponents of industry-funded medical education.

For example, Ivan Goldberg, creator of the popular website Depression Central, and an outspoken critic of drug industry manipulation of doctors, received this letter.Check it out, because it's a little different from the one I got. They offered me $170,000 for 125 presentations (of 45 minutes each), while they offered Dr. Goldberg more money ($179,500) for fewer (only 96) presentations. In a phone conversation with Dr. Goldberg, he suggested that the differential was due to the fact that he lives in expensive New York City, but I assumed that Schering-Plough marketers calculated that he is worth more to them than I am. After all, they also offered Goldberg the lucrative gig of up to 5 "train-the-trainer" spots at $4500 apiece. This is where they would fly him to a meeting to stand at the podium and teach the teeming hordes of wannabe hired guns how to most effectively prostitute themselves.

Why is Schering-Plough sending these corrupting invitations to all the wrong people? Maybe the company employee in charge of identifying potential hired guns simply screwed up and didn't vet the mailing list adequately. Dr. Goldberg offered a different theory. He opined that perhaps all the bad PR about drug companies buying off doctors is dissuading MD's from accepting these gigs. Therefore, perhaps Schering-Plough is now forced to send out invitations to everybody, including "B" players and industry critics, in order to achieve their critical mass of Dr. Drug Reps.

What a fiasco for the company. Talk about a bad stumble as they are about to launch their new antipsychotic. I haven't heard any official Schering-Plough comment on this matter yet, but here is how I predict the statement will read: "Speaker programs are intended to enhance a healthcare professional's knowledge and patient care expertise." Wait--they can't use that line, because it was already used by Eli Lilly. I guess they'll have to make up their own sophisticated BS.

David--I'm not sure what you mean. Google places ads from various companies on sites based on their criteria, such as tags, similarity of content etc.... Anyone who signs up with Google knows that they will have little control over where their ads are placed. Furthermore, most of the ads that Google has placed on my sites are not being directly "bashed" by my content nor are their competition. Nonetheless, that's not my concern. I write what I want to write. If an advertiser sees their ad on my site and doesn't like my article, they are welcome to block their ad from appearing.

Dan: Disclosures are merely the appearance of virtue. They are a lawyer gotcha thing. So I can't criticize you for not adding another.

You have full immunity under the First Amendment and under a statute. I agree, you may write anything you please on the subject of accountability, transparency. You are really a journalist in this context.

Here is a journalist code of ethics. It is totally discretionary. The worst that can happen for a violation is to get called a hypocrite.

http://www.spj.org/ethicscode.asp

Go to the last line. "Abide by the same high standards to which they hold others."

You do not control Google ads except by the content of your posts. So, you write, "CME," you get CME ads.

The New York Times never has a negative article about its frequent advertiser, Saks Fifth Avenue, a troubled company, with indictments, etc. When Saks sacks an employee, they have an article bashing the employee. That hurts the credibility of the NY Times, don't you think?

You do criticize sponsored CME as stealthy advertising. Google is sending fee based CME companies to your site. There is an appearance of advocacy on their behalf.

If Google is generating needed revenue, there is nothing wrong with keeping their ads. If they are not, the appearance of stealthy sponsorship of your blog by fee based CME companies is inconsistent with your opposition to stealthy advertising by sponsorship.

To disclose myself, I served as a speaker for drug companies years ago, but never above 2% of gross income. I disagree that I caused any harm. (Is there any percentage of income where undue influence no longer is a problem for you?)

I got paid to attend consultant meetings. At one of those consultant meetings, an uproar went up from the invited consultants, about the hunger and metabolic syndrome associated with Zyprexa. I had never heard of the metabolic syndrome to that point. This was at a Zyprexa meeting in 1996, right after it came out. That confirmed my clinical experience with the drug was common. I changed my prescribing by no longer giving it to anyone overweight. My paid attendance at a meeting increased my caution, and decreased the number of prescriptions of this really good drug for psychosis.

The fee I received was substantially less than my daily earnings average. I saw it as a sacrifice to improve my knowledge on behalf of my patients.

We do share common ground. 1) We oppose stealthiness in a non-adversarial context such as clinical care. 2) Any disagreement is about methods to best serve patients.

You raise two different, important issues here: 1. Proper firewalls between editorial content and advertising; 2. Ethics of promotional speaking.

On my Google ads, you say:

"You do criticize sponsored CME as stealthy advertising. Google is sending fee based CME companies to your site. There is an appearance of advocacy on their behalf.

If Google is generating needed revenue, there is nothing wrong with keeping their ads. If they are not, the appearance of stealthy sponsorship of your blog by fee based CME companies is inconsistent with your opposition to stealthy advertising by sponsorship."

There is nothing "stealthy" about an advertisement that is clearly an advertisement. On the other hand, there is something stealthy about a CME course claiming to be accredited and therefore independent of drug company influence when in fact the course is artfully, stealthily, biased in favor of the sponsor's product.

I clearly advocate fee-based CME and it is entirely logical that fee-based CME companies would advertise on my site. Where is the hypocrisy here?

To move to your second issue, I don't doubt that many promotional speakers are ethical and use their company-sponsored training programs for the good of patients and their colleagues. But the conflict of interest ensures that some speakers will allow the lure of money to affect their professional judgement. Good on you for having resisted this!

You know, reading over at Furious Seasons tonight about how GSK is being sued for birth defect issues regarding Paxil and there is opening testimony showing internal memos hiding that this was a valid issue, it provokes two reactions:

Disgust, both with the industry and physicians who embraced any and all new medications like the second coming of Christ, and

fright, that as an honest and well intending doctor that you try to help patients with prescribing medications that you think will have more benefits than risks, only to learn that ALL drugs still follow the 4 P's of pharmacology: promise, panacea, placebo, and poison.

And now, I have to put up with the next round of the wonder drugs of antipsychotics and how they will get sold as the panacea for all psychiatric disorders.

I am ashamed to work in a profession that has less integrity almost every day now, and that sucks to have to say this outloud!

By the way, read Glen Gabbard's column in the recent issue of Psychiatric Times, starting off with a recent resident graduate turning down an offer for a group who wanted 10 minute med checks and 30 minute evals. This is beyond disgusting and vile to read, and if you as a psychiatrist either practice this way or know someone who does and say nothing to try to responsibly challenge such disingenuous behaviors, I hope for you there is no afterlife, 'cause you will have a lot of 'splainin' to do if there is!

Skills, I sympathize with your POV, but don't you (and maybe Carlat and Gabbard) think it is time that APA (Schatzberg? LOL), Psychiatry Chairs and Residency Directors take a public stand on this issue? As long as psychiatrists eagerly become intoxicated on Pharma-money, there will be no change. And if they pass this attitude off to residents they teach and supervise, well... what do you expect?

just as a clarification, my comment at the end about "you as a psychiatrist..." was not directed to you specifically, Dr Carlat, but to psychiatrist readers in general, so sorry for the potential misunderstanding, as I doubt you would engage in 10 minute med checks. But to all who do, you are lame.

Speaking of lame and going off topic with this post, but maybe not totally as this issue would affect a new drug like this, this authorization process that holds up patients getting medications is the final straw for me as a provider. Who the hell are these companies to demand we answer to them to allow the patient to use their prescription coverage to get the medications we, as the treating physicians, have legitimately written for in the first place? Anyone who has an effective method to shove this garbage back at the insurer, please comment if Dr Carlat would be kind enough to allow here.

Psychiatry is breaking up on the rocks. It was mostly created by a neurologist as a response to a vacuum of knowledge. What people are pining away for is the humanist philosophy it once had in theory. It gave it away in a legitimate attempt to be a science but psychiatry will never be a science just because it has hijacked its language.Psychiatry should be done by neurologists and should focus purely on major disorders i.e. psychosis, catatonia as a small part of neurologic practice. You do not need a medical degree to talk to people and the field needs to wake up if it is to survive. 30min evals and 10 min med checks are what psychiatry has created for itself. It is a problem because most of the people we are seeing in that time are not even sick. They just need human contact and are unhappy. That is why placebo response rates in studies are so high and increasing. As a field it is too entrenched in our culture to just evaporate and those in power will not give up on it in its current form.Psychiatry has done too much harm medicalising social suffering that would be better dealt with through other means. It promotes disease mongering and pill popping. 10 min med checks and 30 min evals? You reap what you sow!

What is Bipolar Disorder? I have no idea what that word even means at this point.I know what it used to mean. If you mean today's version of 100 flavors where every irritable SOB has BAD, the answer is no. If you mean with true manic psychosis the answer is yes at least in the short term.Talking in an empathic way helps almost everything but I do not see it bringing people out of manic psychosis.

Went to my mail box today to read the new issue of Rolling Stone, and what else is there? This new "Journal" called Journal of ADHD & Related Disorders by APSARD, the American Professional Society of ADHD and Related Disorders, at website www.APSARD.org . I can't find the disclaimer who is behind this publication, but there is s Shire ad in the back, and no one else's ad, so my money is on Shire. Ooops, I missed it as I was typing just now, there it is at the bottom of the cover, as it blurs in with the table of contents, 'CME section supported by an educational grant from Shire'.

This is so pathetic, no matter how much you pine for change, there is none as the profit margin trumps accountability and responsibility fairly much all the time. Sorry I did not read the articles to find out how Shire's product, Concerta if I am correct, shines the brightest among the interventions crowed in the articles. Just thought Dr C and interested parties should be aware.

As to the above comments about Bipolar, if you have "mood swings" or "racing thoughts", then you are Bipolar!!! God forbid it is because you have anxiety driven mood or thought struggles, or mood lability and disjointed thought processes from ADD, or distress from the features from OCD. Swings and racing are the buzz words for only one disorder. These days I see a lot of Bipolar shielding Axis II features, but we as psychiatrists know that is a wasted diagnosis as we won't get reimbursed for it.

The whole revenue model for you guys is screwed up as much as is the influence of the pharmaceutical companies. Why not just forget reimbursement altogether and charge $250 an hour while doing disability evals for $2,000 a pop, forensic work for more money, and tell the insurance companies to take a hike? That is what my psych has done.

Now, he may still very well be still under the spell of Lilly, Forrest, and the rest. But the 15 prescriptions he has me on won't give me enough energy or memory to ask him about it. Lol.

Actually, he is quite good I think but you never know if he is one who feels a pill will do regardless of what non-pharmacological possibilities exist.

As for bipolar, I agree with Dr. Anon. The current choices for BP resemble 31 flavors at Baskin Robbins. You guys could fix this with the DSM V< but I read that committee has already experienced trouble and undue influence.

At least you all are not in the financial world. There you have the good guys - fee-only fiduciary advisors - versus everyone else - insurers, brokers, wall street firms, annuity companies, and the like. There, as in your profession, the good guys are way outnumbered and out manned.

Back to the question of why a drug company might solicit industry critics to be speakers. I doubt it was desperation to find willing participants; there are still a great many non-critical MDs who would respond to such offers. If it wasn't simply a stupid mistake, another possibility is a calculated effort to silence critics by buying them off. Perhaps not outspoken bloggers like Carlat and Goldberg, but maybe others who would swallow their principles for $170k. It's a lot of money for the average psychiatrist, not to mention most everyone else.